Provider Demographics
NPI:1235607722
Name:SHERWOOD, EDWIN GRANT (PHARMD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:GRANT
Last Name:SHERWOOD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5104 SE RURAL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-8366
Mailing Address - Country:US
Mailing Address - Phone:501-827-0024
Mailing Address - Fax:
Practice Address - Street 1:240 NW LOST SPRINGS TER STE 36
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-6571
Practice Address - Country:US
Practice Address - Phone:503-596-3552
Practice Address - Fax:503-596-3558
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60879431183500000X
ORRPH0016808183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist